title: A quality improvement initiative using a novel travel survey to promote patient-centered counseling.
abstract: BACKGROUND
  We sought to evaluate and provide better itinerary-specific care to precounseled travelers and to assess diseases occurring while traveling abroad by surveying a community population. An additional quality improvement initiative was to expand our post-travel survey to be a more valuable tool in gathering high-quality quantitative data.
  
  
  METHODS
  From de-identified data collected via post-travel surveys, we identified a cohort of 525 patients for a retrospective observational analysis. We analyzed illness encountered while abroad, medication use, and whether a physician was consulted. We also examined itinerary variables, including continents and countries visited.
  
  
  RESULTS
  The 525 post-travel surveys collected showed that the majority of respondents traveled to Asia (31%) or Africa (30%). The mean number of travel days was 21.3 (median, 14). Univariate analysis demonstrated a statistically significant increase of risk for general illness when comparing travel duration of less than 14 days to greater than 14 days (11.3% vs 27.7%, p < 0.001). Duration of travel was also significant with regard to development of traveler's diarrhea (TD) (p = 0.0015). Destination of travel and development of traveler's diarrhea trended toward significance. Serious illness requiring a physician visit was infrequent, as were vaccine-related complications.
  
  
  CONCLUSIONS
  Despite pre-travel counseling, traveler's diarrhea was the most common illness in our cohort; expanded prevention strategies will be necessary to lower the impact that diarrheal illness has on generally healthy travelers. Overall rates of illness did not vary by destination; however, there was a strong association between duration of travel and likelihood of illness. To further identify specific variables contributing to travel-related disease, including patient co-morbidities, reason for travel, and accommodations, the post-travel survey has been modified and expanded. A limitation of this study was the low survey response rate (18%); to improve the return rate, we plan to implement supplemental modalities including email and a web-based database.
authors.affiliation: Department of General Internal Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Mackaness
authors.forename: Allison
authors.initials: A
authors.lastname: Osborne
authors.forename: Deepti
authors.initials: D
authors.lastname: Verma
authors.forename: Suzanne
authors.initials: S
authors.lastname: Templer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Weiss
authors.forename: Mark C
authors.initials: MC
authors.lastname: Knouse
mesh_terms: D000349:Africa / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D003376:Counseling / Q000592:standards*; D006801:Humans; D007239:Infections / Q000208:ethnology*; D020407:Internet; D018802:Patient-Centered Care / Q000592:standards*; D010414:Pennsylvania / Q000453:epidemiology; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014195:Travel